TIAs and strokes are an emergency, but stroke victims are avoiding the Emergency Room

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A Dangerous Trend

UH Clinical Update | April 2020

By Cathy Sila, MD, Chair, Department of Neurology, UH Cleveland Medical Center

“I thought it was going to get better.”

Cathy Sila, MDCathy Sila, MD

He first noticed clumsiness in his right hand - couldn’t type, dropped his coffee. The first thing he thought of was, “I am having a stroke,” but minutes later, it seemed better so he dismissed the thought. But when he tried to get up from his desk and his right leg gave way, he got worried but decided to lie down and rest. A few hours later, he woke up and couldn’t lift his right arm, and when he called out for his wife, his speech was slurred. She immediately dialed 911, saying, “Please hurry, my husband is having a stroke!” As they anxiously awaited the few minutes for EMS to arrive, he told her “I thought it was going to get better”. 

As a stroke specialist, I have sadly heard that story many times. Stroke symptoms - weakness on one side of the body, loss of feeling or vision, inability to think or speak - are very frightening.  Many of us know someone who has had a stroke, and the need to deny that this could be happening is sometimes very strong.  

What really has me worried now is that since March, most stroke centers across the U.S., including ours at University Hospitals, have noted a dramatic decline of 30 percent or more in stroke admissions from the Emergency Room. In the hospital, we have also seen an alarming shift in the types of stroke, with most patients having a very severe stroke. That has prompted many of us to think the fear of COVID-19 is preventing stroke victims from seeking out emergency care that could save their life and reduce their risk of disability from a stroke. We need to reassure patients and families that University Hospitals’ Emergency Rooms are open 24/7/365 to provide that life-saving care and following best practices for cleanliness, infection control and employee health so our patients and staff stay healthy.        

Why are TIAs and strokes a medical emergency? In the first few days, 5-10 percent of TIAs are followed by a stroke, and 20 percent of strokes can progress or worsen. Emergency testing and treatment can significantly reduce those risks, to 2 percent or less. And in the case of an acute stroke where an artery is blocked, we have effective treatments to restore blood flow to the brain, like tPA and mechanical thrombectomy. These life-saving treatments are only effective if given before the brain cells are irreversibly injured, and are most beneficial when treatment starts within hours of stroke symptoms.

Make sure your patients know the warning signs of stroke and to always call 911 if they’re having worrisome symptoms. The emergency treatment we provide at UH could save their life.

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